Combined spinal and epidural anesthesia in a parturient with idiopathic hypertrophic subaortic stenosis

Idiopathic hypertrophic subaortic stenosis (IHSS), also known as hypertrophic obstructive cardiomyopathy, is characterized by dynamic obstruction of the left ventricular outflow tract secondary to asymmetric hypertrophy of the ventricular septum. Pregnancy is usually well tolerated, but acute peripartum pulmonary edema and a fatal ventricular arrhythmia have been reported. [1,2] Epidural anesthesia for vaginal delivery and general anesthesia for cesarean section have been described previously. [3,4] We report the use of combined spinal and epidural anesthesia using intrathecal fentanyl followed by epidural infusion of a diluted bupivacaine-fentanyl infusion for pain relief during labor and delivery in a parturient with IHS